Search Results (110)

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

Background/Objectives: Persistent breathlessness impacts people living with advanced chronic obstructive pulmonary disease (COPD) and carers. Accessible services are limited. This translational pilot study evaluated the feasibility, impacts on patient and carer-reported outcomes, and hospital use of a home-based breathlessness intervention service (BLIS). Methods: People with stable COPD, ≥1 COPD-related hospital admissions in the previous year, and persistent breathlessness participated in a pre–post study. The BLIS program involved home visits/phone contacts by a nurse/physiotherapist (average 8 contacts, 7 weeks). Uptake, retention, and fidelity were recorded prospectively, and participant experience was explored (post-program interviews). Breathing discomfort (Multidimensional Dyspnea Profile A1 scale), threat (Brief Illness Perception Questionnaire), and carer stress/strain (Zarit Burden Interview) were compared pre- and post-program (week 9, 3 and 6 months) using mean difference and 95% confidence intervals (CIs). Hospital use for COPD-related causes in 12 months before/after participation was reported. Results: A total of 16/19 eligible people agreed to participate, and 15/16 completed the program. In participants with COPD (73 [9] years, FEV1%pred 42% [15], mean [SD]; a median of 3 COPD-related hospital admissions in the previous year) and carers (n = 6), BLIS was highly (in 95%) acceptable. Compared to pre-program, breathing discomfort was reduced in week 9 and 6 months; breathlessness threat was reduced in week 9 and 3 months; and carer burden was reduced at 6 months. Compared to the 12 months prior, hospital admissions decreased in the 12 months post-program. Conclusions: Translation of this service to the local setting was feasible, with high program uptake and retention. Post-program improvements in key patient- and carer-reported outcomes and a reduction in public hospital admissions support the implementation of the BLIS program for this cohort in this setting. Full article

Background: Early rehabilitation is crucial for predicting post-stroke outcomes. In rural Thailand, previous works identified limited access to prompt rehabilitation services, discontinuity of home visits, and a lack of interdisciplinary management, hindering comprehensive resolution. Objective: This participatory action research-based pilot quasi-experimental study investigated the effects of personalized intermediate care (IMC) programs led by physical therapists on clinical outcomes in post-ischemic stroke older adults living in rural areas. Methods: Participatory stakeholders (two physical therapists, a physician, a nurse, and a nutritionist) convened to coordinate with relevant stakeholders (community leaders, village health volunteers (VHVs), and family caregivers (CGs)). Thirty-four acute post-stroke patients were included in the study. The interventions consisted of three action research cycles (planning, action, observation, and reflection) of home-based neurorehabilitation and comprehensive treatments by a healthcare professional network for six months and another six-month follow-up. The primary outcome was the Barthel index for activities of daily living (BI-ADL). The modified Rankin scale (mRS) was a secondary outcome for assessing disability levels. Results: Results showed that the BI-ADL gradually and significantly increased from a baseline median (IQR) of 55 (15) to 100 (20) after 6 months (p < 0.05). This improvement of the BI-ADL was maintained after 12 months (100 (15)). Furthermore, the mRS at 6 months post-discharge reduced considerably from the first month of rehabilitation (p < 0.05). Conclusions: In conclusion, the early and continuous personalized IMC rehabilitation program effectively enhanced ADL and reduced disability levels and should be disseminated to the community. Full article

This study aimed to evaluate the effects of community nursing simulation education on the nursing core competencies, clinical performance, and clinical judgment in home-visit nursing of nursing college students. A nonequivalent control group pretest–post-test design was used. Data were collected in August 2024 from the control group (n = 65) and in February 2025 from the experimental group (n = 64), with both groups comprising fourth-year students older than 20 years and from the same nursing college in Korea. Data analysis included an independent t-test carried out using SPSS 25.0 software. We found significant differences between the control and experimental groups in terms of the students’ nursing core competence (t = 4.88, p < 0.001, Cohen’s d = 0.86), clinical judgment (t = 4.53, p < 0.001, Cohen’s d = 0.80), and clinical competence (t = 4.52, p < 0.001, Cohen’s d = 0.00). The simulation education program applied in this study can be utilized as an intervention for nursing college students and be further developed for nursing students from other universities. Full article

Background/Objectives: Hospital readmissions are a key quality metric impacting both patient outcomes and healthcare costs. Traditional logistic regression models, including the LACE index (Length of stay, Admission type, Comorbidity index, and recent Emergency department visits), are commonly used for readmission risk stratification, though their accuracy may be limited by non-linear interactions with other clinical variables. This study compared the predictive performance of non-linear machine learning (ML) models with stepwise logistic regression (LR) and the LACE index for predicting 30-day general medicine readmissions. Methods: We retrospectively analysed adult general medical admissions at a tertiary hospital in Australia from 1 July 2022 to 30 June 2023. Thirty-two variables were extracted from electronic medical records, including demographics, comorbidities, prior healthcare use, socioeconomic status (SES), laboratory data, and frailty (measured by the Hospital Frailty Risk Score). Predictive models included stepwise LR and four ML algorithms: Least Absolute Shrinkage and Selection Operator (LASSO), random forest, Extreme Gradient Boosting (XGBoost), and artificial neural networks (ANNs). Performance was assessed using the area under the curve (AUC), with comparisons made using DeLong’s test. Results: Of 5371 admissions, 1024 (19.1%) resulted in 30-day readmissions. Readmitted patients were older and frailer and had more comorbidities and lower SES. Logistic regression (LR) identified the key predictors of outcomes, including heart failure, alcoholism, nursing home residency, and prior admissions, achieving an AUC of 0.62. LR’s performance was comparable to that of the LACE index (AUC = 0.61) and machine learning models: LASSO (AUC = 0.63), random forest (AUC = 0.60), and artificial neural networks (ANNs) (AUC = 0.60) (p > 0.05). However, LR significantly outperformed XGBoost (AUC = 0.55) (p < 0.05). Conclusions: About one in five general medicine patients are readmitted within 30 days. Traditional LR performed as well as or better than ML models for readmission risk prediction. Full article

Background/Objectives: Sedentary office workers (SOWs) often adopt prolonged sitting postures, which potentially disrupt the lumbar–pelvic rhythm (LPR) and contribute to lower back pain (LBP). This study aimed to clarify the group differences in LPR and related physical factors between SOWs with and without LBP. Methods: Sixty-three SOWs were divided into LBP (n = 30) and non-LBP (n = 33) groups. The lumbar flexion angle (LF) and lumbar–hip angle difference (LHD), which are indicators of LPR, were measured using inertial sensors during trunk flexion. Hip flexion muscle strength (HFMS) and hip-extension muscle strength (HEMS) were assessed using handheld dynamometry. Hip joint range of motion (ROM) was measured using a goniometer. Lumbar proprioception was evaluated via active joint repositioning, and pain and perception were assessed using the Visual Analog Scale, Oswestry Disability Index, and Fremantle Back Awareness Questionnaire. Results: Multiple regression analysis showed significantly greater LF (estimated regression coefficient [ERC]: −2.9, p < 0.05) and LHD (ERC: −5.5, p < 0.05) during early trunk flexion (ETF) in the LBP group. In the LBP group, LHD during ETF and late trunk flexion were positively correlated with HFMS, and HFMS was correlated with HEMS. Conclusions: HFMS may contribute to an altered LPR in SOWs with LBP. Full article

Access to healthcare services in rural areas of Peru remains a challenge, with marked differences compared to urban areas. Despite the importance of primary healthcare (PHC) in these communities, the rural population has a negative perception of the role of nursing staff. This study aimed to assess the perceptions of residents in the highland communities of Huata and Ichu, Province of Puno, located in southern Peru, regarding the role of nursing professionals. The general perception of the residents was first analyzed, followed by an evaluation of two dimensions (Fieldwork and Health Education), which allowed for the development of the REFCO (Role of the Nursing professional in the community) scale. The sample included 329 rural adults, mainly between 30 and 59, predominantly female, with incomplete secondary education. The results showed an unfavorable perception (54%) of nursing staff performance. The fieldwork dimension reported low visibility of nursing activities in the community, such as home visits and health programs. The second dimension demonstrated that educational interventions were perceived as infrequent and of low impact, with insufficient adaptation to local needs. These results highlight the need to strengthen the presence and educational strategies of nursing staff in alignment with the cultural and demographic realities of rural communities. Furthermore, it suggests a greater need for interinstitutional collaboration and a more personalized approach to community activities to improve the perception and effectiveness of healthcare services in these areas. Full article

Enhancing maternal and newborn care is a key priority for governments worldwide. World leaders have taken deliberate steps to improve these essential services, with an emphasis on postnatal care, including home visits for mothers and their newborns. However, in the Ashanti Region and across Ghana, challenges surrounding the delivery and effectiveness of postnatal home visits remain a significant concern. This study aimed to assess the attitudes of Community Health Nurses towards postnatal home visitation in selected districts of the Ashanti Region. A quantitative survey approach was used to gather data from 100 CHNs randomly selected from 10 regional districts. Structured questionnaires were used to gather quantitative data from CHNs. Findings from the study were analysed using descriptive and inferential tests. The study results indicated that most of the CHNs were young adults, 35 years of age (79%), with the majority having 3–5 years of work experience. The respondents generally demonstrated a negative attitude towards PNHV as they believed it was an extra workload, time-consuming, and unnecessary. A Pearson chi-square test indicated strong significant association between CHNs’ attitude towards the components of the attitude scale and years of experience as well as their age. In conclusion, the study revealed that even though CHNs are expected, as part of their job description, to embark on home visitation activities, most of them have a negative attitude towards this professional duty. There should be conscientious, novel ways to ignite the interest of these essential service providers to help improve infant and maternal health. Full article

Background/Objectives: Polymorbidity and polypharmacy are major challenges in geriatric care, resulting in a reduced quality of life and increased health care costs. Methods: We evaluated the proactive medication management of nursing home residents through personal visits and the use of a clinical decision support system (CDSS) with an integrated Beers Criteria list. Results: Among 56 nursing home residents, we observed a high prevalence of polypharmacy with an average of 7.9 regular and 5.1 on-demand prescriptions. Proactive medication management led to persistent medication changes in 87.5% of patients. Regular prescriptions were reduced in 21 residents and increased in 18 residents, resulting in a reduced use of cardiovascular drugs and antacids (p < 0.05), but no significant overall reduction in polypharmacy. CDSS alerts based on Beers Criteria made no clinically relevant contribution to medication reduction. Conclusions: Proactive geriatric medication management led to persistent medication changes and no reduction in overall polypharmacy but reduced the use of selected drug classes that are associated with an increased risk of adverse reactions and costs. The clinical relevance and implementability of Beers Criteria were low, revealing major limitations of algorithm-based alerts for older patients, who require additional personalized evaluations of their individual complex healthcare needs. Full article

Background: Despite the ongoing innovations and the availability of numerous effective inhaled treatment options, achieving optimal disease control in most patients frequently remains disappointing. Unfortunately, although inhaled therapy is the cornerstone of respiratory disease management, the selection of the most appropriate inhaler is still overlooked or underestimated by some healthcare professionals, and inhaler misuse remains a significant challenge in managing chronic respiratory diseases which directly influences patients’ quality of life, clinical outcomes, and risk of disease progression. Materials and Methods: This is a unicentric, observational, cross-sectional study designed to evaluate the inhaled therapy prescribed in hospitalized patients and to analyze device changes after hospitalization, as well as the factors associated with these changes. A single face-to-face visit was performed during the patient’s hospitalization, where the inhaled therapy used prior to hospitalization was evaluated: technique (critical errors), compliance (TAI questionnaire), maximum peak inspiratory flow [PIF (L/min)], and level of inhaler handling-related knowledge. A binary logistic regression model was used to explore the association between changing device at discharge and the other independent variables Results: The inhaler most used during hospitalization was the metered-dose inhaler (MDI) with a chamber (51.9% of patients), with the dry powdered inhalers (DPI) being the inhalers used in 43% of maintenance inhaled therapies in the community setting prior to hospitalization. In addition, 90% of patients showed a maximum PIF ≥ 30 L/min, and 35.6% performed critical inhaler errors. These patients had statistically significantly lower maximum PIF values (52.1 L/min in patients with critical inhaler errors vs. 60.8 L/min without critical inhaler errors; p > 0.001) and were more likely to exhibit poor inhaler compliance compared to those without critical errors (50.5% vs. 31.0%, respectively). More than half of the patients who used MDI with spacer chamber made critical inhaler errors; 69.9% showed regular or poor treatment adherence, although 75.6% demonstrated good knowledge about inhaler handling. Only in 27% of the patients did the healthcare professional change the type of inhaler after hospitalization within clinical practice. The medical and nursing staff responsible for the patient’s hospitalization were not informed of the assessment carried out in the study. The probability of not performing a device change at discharge was lower in patients with previous at-home treatment with combined inhaled therapy with LABA + ICS (OR 0.3 [0.18–0.83], p = 0.016) and in patients under triple inhaled therapy (OR 0.3 [0.17–0.76], p = 0.007). No significant differences were observed in inhaler changes when considering the frequency of critical inhaler errors, inhaler handling-related knowledge or maximum PIF values. Conclusions: Our study highlights the urgent need for a more personalized inhaler selection and consistent monitoring by healthcare professionals to minimize inhaler misuse, increase treatment compliance and adherence, and improve disease management outcomes. It is essential to provide training and promote the role of nursing in the evaluation and education of inhaled therapy. Additionally, the use of standardized approaches and tools, such as the CHECK DIAL, is crucial to facilitate the adaptation of devices to patients’ needs. Full article

On 1 January 2024, a magnitude 7.5 earthquake struck the Noto Peninsula in Ishikawa Prefecture, Japan, causing substantial damage to northern Noto. This study aimed to clarify the experiences of patients using a psychiatric visiting nurse service who were affected by the earthquake, and the influencing factors of worsening mental health symptoms after the earthquake. Participants were 114 patients using a psychiatric visiting nurse service in northern Noto. Data were collected retrospectively from nursing records. Factors associated with signs of worsening mental health symptoms were the continued use of home visiting nursing services after the disaster (n = 43, 46.7%; p = 0.040) and the intervention of a disaster psychiatric assistance team (DPAT) (n = 7, 77.8%; p = 0.034). No significant correlation was found between the number of relocations owing to evacuation and signs of worsening mental health symptoms. Although 61.4% of participants experienced more than one evacuation, the number of evacuations and relocations did not seem to directly affect the worsening of mental health symptoms. However, the results suggest a need for more direct interventions, such as the continued use of home visiting nursing services and the involvement of DPATs as an external resource, for patients exhibiting signs of worsening mental health symptoms. Full article

Background/Objectives: The COVID-19 pandemic compelled countries worldwide to implement stringent visitation restrictions across hospitals, nursing homes, and long-term care facilities to mitigate viral transmission. While initially justified by the uncertainty surrounding the virus, these restrictions often lasted well beyond the acute stage of the pandemic, leading to substantial psychological and physical harm, particularly for older adults. This study assesses the effects of these controls and offers strategies to balance public health priorities with patients’ rights and psychological well-being during public health crises. Methods: An integrative review and comparative analysis of legislative measures and the psychological effects of visitation restrictions was undertaken. International and national visitation regulations and case studies were reviewed, and ethical frameworks were considered. Results: Our findings indicate that prolonged isolation due to extended visitation restrictions led to higher rates of anxiety, depression, and delirium among patients, creating ethical dilemmas for healthcare providers. Legal responses to this challenge varied globally. International human rights organizations called for policies bridging public health priorities with patients’ rights to family and caregiver support. Some U.S. states enacted proactive legislation to strengthen family visitation rights, while other jurisdictions lack these visitation protections. Conclusions: Prolonged visitation restrictions during the pandemic show the need for legislation integrating public health protections with in-person family and caregiver support. The ethical imperatives of limiting the psychological harm caused by healthcare isolation and the legislative solutions to protect public health and the psychological well-being of patients during health crises are discussed. Full article

Aim: As the population is aging, falls by older people, in particular falls from four-wheeled walkers (“rollators”), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences. Methods: This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures. Results: A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75–84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001). Conclusion: Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population. Full article

In light of the demographic shift towards an aging population, there is an increasing prevalence of dementia among the elderly. The negative impact on mental health is preventing individuals from taking proper care of themselves. For individuals requiring hospital care, those receiving home care, or as a precaution for a specific individual, it is advantageous to utilize monitoring equipment to track their biological parameters on an ongoing basis. This equipment can minimize the risk of serious accidents or severe health hazards. The objective of the present research project is to design an armband with an accurate location tracking system. This is of particular importance for individuals with dementia and Alzheimer’s disease, who frequently leave their homes and are unable to find their way back. The proposed armband also includes a fingerprint identification system that allows only authorized personnel to use it. Furthermore, in hospitals and healthcare facilities the biometric identification system can be used to trace periodic medical or nursing visits. This process improves the reliability and transparency of healthcare. The test results indicate that the armband functions in accordance with the desired design specifications, with performance evaluation of the main features including fall detection, where a hit rate of 100% was obtained, a fingerprint recognition test demonstrating accuracy from 88% to 100% on high-quality samples, and a GPS tracking test determining position with a difference of between 1.8 and 2.1 m. The proposed solution may be of benefit to healthcare professionals, supported housing providers, elderly people as target users, or their family members. Full article